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Shunichi Homma - One of the best experts on this subject based on the ideXlab platform.

  • Patent Foramen Ovale
    Nature Reviews Disease Primers, 2016
    Co-Authors: Shunichi Homma, Steven R Messe, Tatjana Rundek, Jennifer Franke, Horst Sievert, Ralph L Sacco, Yee-ping Sun, Karina Davidson, Marco R Di Tullio
    Abstract:

    Patent Foramen Ovale (PFO) is the most common congenital heart abnormality and is present in approximately ∼25% of the adult population. In this Primer, Homma et al. describe various aspects of PFOs, focusing on their potential relationship with stroke. Patent Foramen Ovale (PFO) is the most common congenital heart abnormality of fetal origin and is present in approximately ∼25% of the worldwide adult population. PFO is the consequence of failed closure of the Foramen Ovale, a normal structure that exists in the fetus to direct blood flow directly from the right to the left atrium, bypassing the pulmonary circulation. PFO has historically been associated with an increased risk of stroke, the mechanism of which has been attributed to the paradoxical embolism of venous thrombi that shunt through the PFO directly to the left atrium. However, several studies have failed to show an increased risk of stroke in asymptomatic patients with a PFO, and the risk of stroke recurrence is low in patients who have had a stroke that may be attributed to a PFO. With the advent of transoesophageal and transthoracic echocardiography, as well as transcranial Doppler, a PFO can be routinely detected in clinical practice. Medical treatment with either antiplatelet or anticoagulation therapy is recommended. At the current time, closure of the PFO by percutaneous interventional techniques does not appear to reduce the risk of stroke compared to conventional medical treatment, as shown by three large clinical trials. Considerable controversy remains regarding the optimal treatment strategy for patients with both cryptogenic stroke and PFO. This Primer discusses the epidemiology, mechanisms, pathophysiology, diagnosis, screening, management and effects on quality of life of PFO.

  • Patent Foramen Ovale
    Nature reviews. Disease primers, 2015
    Co-Authors: Shunichi Homma, Steven R Messe, Tatjana Rundek, Jennifer Franke, Karina W Davidson, Horst Sievert, Ralph L Sacco, Marco R Di Tullio
    Abstract:

    Patent Foramen Ovale (PFO) and atrial-septal aneurysm (ASA) are congenital cardiac abnormalities that are highly prevalent in the general population. Observational studies have found an association between these anomalies and several neurologic diseases, including stroke, decompression sickness from SCUBA diving, migraine, and others. In this chapter, we will discuss the diagnosis of PFO and ASA, review the data that implicate them as causes of neurologic disorders—particularly cryptogenic stroke in the young—and assess the available treatment options.

  • Patent Foramen Ovale and stroke
    Journal of Cardiology, 2010
    Co-Authors: Shunichi Homma, Marco R Di Tullio
    Abstract:

    The presence of a Patent Foramen Ovale has been found to be associated with an increased risk of ischemic stroke of otherwise unknown origin (cryptogenic stroke). The present article will review the evidence regarding this association, the technical aspects of PFO detection, and the preventive options to decrease the risk of recurrent cerebral events.

  • Patent Foramen Ovale and stroke
    Circulation, 2005
    Co-Authors: Shunichi Homma, Ralph L Sacco
    Abstract:

    Observational data from prospective and retrospective trials indicate that a Patent Foramen Ovale (PFO) is associated with the risk of ischemic stroke. The mechanism involved is presumed to be paradoxical embolism from a venous thrombus that travels via the PFO to the systemic circulation causing an ischemic stroke. Primary stroke prevention data for patients with a PFO are nonexistent. Given the substantial prevalence of PFO in the total population (≈25% to 30%), a primary prevention study may not be feasible. However, whether targeted primary prevention for patients with PFOs of certain morphologic characteristics (eg, larger size, greater degree of shunt) would be possible remains undefined. Given the large number of asymptomatic subjects, no therapy is currently recommended. The best treatment modality to prevent recurrent stroke in patients with PFO has not been defined. There are four major treatment choices: surgical closure, percutaneous device closure, medical therapy with anticoagulants, and medical therapy with antiplatelet agents. Regarding medical therapy, the Patent Foramen Ovale in Cryptogenic Stroke Study has demonstrated that antiplatelet and anticoagulant therapies are of equal benefit in preventing recurrent adverse events. Although closure of the PFO, either surgical or percutaneous, may further reduce the event rates, this remains to be demonstrated because no randomized trial to date has compared PFO closure with medical therapy.

  • Patent Foramen Ovale presenting as platypnea-orthodeoxia: diagnosis by transesophageal echocardiography.
    Journal of The American Society of Echocardiography, 2001
    Co-Authors: Miriam Roxas-timonera, Marco R Di Tullio, Cristina Larracas, Deborah R. Gersony, Andrew M. Keller, Shunichi Homma
    Abstract:

    Platypnea-orthodeoxia is a rare syndrome that is often associated with interatrial shunting through a Patent Foramen Ovale or atrial septal defect. we describe the case of a 65-year-old woman with progressive dyspnea and hypoxia when standing and walking, which was relieved by assuming the recumbent position. The diagnosis was confirmed by tilt-table transesophageal echocardiography demonstrating a large right- to-left shunt through a Patent Foramen Ovale while the patient was in a semiupright position and no significant shunt while in a recumbent position. This case demonstrates that platypnea-orthodeoxia caused by a Patent Foramen Ovale can be clearly demonstrated by the technique of contrast transesophageal echocardiography performed on a tilt table.

Marco R Di Tullio - One of the best experts on this subject based on the ideXlab platform.

  • Patent Foramen Ovale
    Nature Reviews Disease Primers, 2016
    Co-Authors: Shunichi Homma, Steven R Messe, Tatjana Rundek, Jennifer Franke, Horst Sievert, Ralph L Sacco, Yee-ping Sun, Karina Davidson, Marco R Di Tullio
    Abstract:

    Patent Foramen Ovale (PFO) is the most common congenital heart abnormality and is present in approximately ∼25% of the adult population. In this Primer, Homma et al. describe various aspects of PFOs, focusing on their potential relationship with stroke. Patent Foramen Ovale (PFO) is the most common congenital heart abnormality of fetal origin and is present in approximately ∼25% of the worldwide adult population. PFO is the consequence of failed closure of the Foramen Ovale, a normal structure that exists in the fetus to direct blood flow directly from the right to the left atrium, bypassing the pulmonary circulation. PFO has historically been associated with an increased risk of stroke, the mechanism of which has been attributed to the paradoxical embolism of venous thrombi that shunt through the PFO directly to the left atrium. However, several studies have failed to show an increased risk of stroke in asymptomatic patients with a PFO, and the risk of stroke recurrence is low in patients who have had a stroke that may be attributed to a PFO. With the advent of transoesophageal and transthoracic echocardiography, as well as transcranial Doppler, a PFO can be routinely detected in clinical practice. Medical treatment with either antiplatelet or anticoagulation therapy is recommended. At the current time, closure of the PFO by percutaneous interventional techniques does not appear to reduce the risk of stroke compared to conventional medical treatment, as shown by three large clinical trials. Considerable controversy remains regarding the optimal treatment strategy for patients with both cryptogenic stroke and PFO. This Primer discusses the epidemiology, mechanisms, pathophysiology, diagnosis, screening, management and effects on quality of life of PFO.

  • Patent Foramen Ovale
    Nature reviews. Disease primers, 2015
    Co-Authors: Shunichi Homma, Steven R Messe, Tatjana Rundek, Jennifer Franke, Karina W Davidson, Horst Sievert, Ralph L Sacco, Marco R Di Tullio
    Abstract:

    Patent Foramen Ovale (PFO) and atrial-septal aneurysm (ASA) are congenital cardiac abnormalities that are highly prevalent in the general population. Observational studies have found an association between these anomalies and several neurologic diseases, including stroke, decompression sickness from SCUBA diving, migraine, and others. In this chapter, we will discuss the diagnosis of PFO and ASA, review the data that implicate them as causes of neurologic disorders—particularly cryptogenic stroke in the young—and assess the available treatment options.

  • Patent Foramen Ovale and stroke
    Journal of Cardiology, 2010
    Co-Authors: Shunichi Homma, Marco R Di Tullio
    Abstract:

    The presence of a Patent Foramen Ovale has been found to be associated with an increased risk of ischemic stroke of otherwise unknown origin (cryptogenic stroke). The present article will review the evidence regarding this association, the technical aspects of PFO detection, and the preventive options to decrease the risk of recurrent cerebral events.

  • Patent Foramen Ovale presenting as platypnea-orthodeoxia: diagnosis by transesophageal echocardiography.
    Journal of The American Society of Echocardiography, 2001
    Co-Authors: Miriam Roxas-timonera, Marco R Di Tullio, Cristina Larracas, Deborah R. Gersony, Andrew M. Keller, Shunichi Homma
    Abstract:

    Platypnea-orthodeoxia is a rare syndrome that is often associated with interatrial shunting through a Patent Foramen Ovale or atrial septal defect. we describe the case of a 65-year-old woman with progressive dyspnea and hypoxia when standing and walking, which was relieved by assuming the recumbent position. The diagnosis was confirmed by tilt-table transesophageal echocardiography demonstrating a large right- to-left shunt through a Patent Foramen Ovale while the patient was in a semiupright position and no significant shunt while in a recumbent position. This case demonstrates that platypnea-orthodeoxia caused by a Patent Foramen Ovale can be clearly demonstrated by the technique of contrast transesophageal echocardiography performed on a tilt table.

  • characteristics of Patent Foramen Ovale associated with cryptogenic stroke a biplane transesophageal echocardiographic study
    Stroke, 1994
    Co-Authors: Shunichi Homma, Ralph L Sacco, Marco R Di Tullio, D Mihalatos, Li G Mandri, J P Mohr
    Abstract:

    Patent Foramen Ovale is associated with ischemic stroke in patients without a clearly identifiable etiology for stroke (cryptogenic stroke). Paradoxical embolization is thought to be a potential mechanism. However, Patent Foramen Ovale is also found in patients with known cause of stroke. Therefore, using contrast transesophageal echocardiography, we characterized the Patent Foramen Ovale in cryptogenic stroke patients to assess morphological factors that may contribute to paradoxical embolization. Contrast transesophageal echocardiographic studies of 74 consecutive patients referred for ischemic stroke were reviewed. Twenty-three patients with Patent Foramen Ovale were identified. These patients were classified as having strokes of determined origin or cryptogenic strokes according to criteria developed for the Stroke Data Bank of the National Institute of Neurological Disorders and Stroke. Separation of septum primum from secundum and the number of microbubbles appearing in left atrium were then quantitated. These parameters were compared between patients with cryptogenic stroke and those with known cause of stroke. The Patent Foramen Ovale dimension was significantly larger in patients with cryptogenic stroke compared with patients with an identifiable cause of stroke (2.1 +/- 1.7 mm versus 0.57 +/- 0.78 mm [mean +/- SD]; P Patients with cryptogenic stroke have larger Patent Foramen Ovale with more extensive right-to-left interatrial shunting than patients with stroke of determined cause. Transesophageal echocardiographically identifiable characteristics of Patent Foramen Ovale may be important in defining the clinical significance of individual Patent foramina.

Ralph L Sacco - One of the best experts on this subject based on the ideXlab platform.

  • Patent Foramen Ovale
    Nature Reviews Disease Primers, 2016
    Co-Authors: Shunichi Homma, Steven R Messe, Tatjana Rundek, Jennifer Franke, Horst Sievert, Ralph L Sacco, Yee-ping Sun, Karina Davidson, Marco R Di Tullio
    Abstract:

    Patent Foramen Ovale (PFO) is the most common congenital heart abnormality and is present in approximately ∼25% of the adult population. In this Primer, Homma et al. describe various aspects of PFOs, focusing on their potential relationship with stroke. Patent Foramen Ovale (PFO) is the most common congenital heart abnormality of fetal origin and is present in approximately ∼25% of the worldwide adult population. PFO is the consequence of failed closure of the Foramen Ovale, a normal structure that exists in the fetus to direct blood flow directly from the right to the left atrium, bypassing the pulmonary circulation. PFO has historically been associated with an increased risk of stroke, the mechanism of which has been attributed to the paradoxical embolism of venous thrombi that shunt through the PFO directly to the left atrium. However, several studies have failed to show an increased risk of stroke in asymptomatic patients with a PFO, and the risk of stroke recurrence is low in patients who have had a stroke that may be attributed to a PFO. With the advent of transoesophageal and transthoracic echocardiography, as well as transcranial Doppler, a PFO can be routinely detected in clinical practice. Medical treatment with either antiplatelet or anticoagulation therapy is recommended. At the current time, closure of the PFO by percutaneous interventional techniques does not appear to reduce the risk of stroke compared to conventional medical treatment, as shown by three large clinical trials. Considerable controversy remains regarding the optimal treatment strategy for patients with both cryptogenic stroke and PFO. This Primer discusses the epidemiology, mechanisms, pathophysiology, diagnosis, screening, management and effects on quality of life of PFO.

  • Patent Foramen Ovale
    Nature reviews. Disease primers, 2015
    Co-Authors: Shunichi Homma, Steven R Messe, Tatjana Rundek, Jennifer Franke, Karina W Davidson, Horst Sievert, Ralph L Sacco, Marco R Di Tullio
    Abstract:

    Patent Foramen Ovale (PFO) and atrial-septal aneurysm (ASA) are congenital cardiac abnormalities that are highly prevalent in the general population. Observational studies have found an association between these anomalies and several neurologic diseases, including stroke, decompression sickness from SCUBA diving, migraine, and others. In this chapter, we will discuss the diagnosis of PFO and ASA, review the data that implicate them as causes of neurologic disorders—particularly cryptogenic stroke in the young—and assess the available treatment options.

  • Patent Foramen Ovale and stroke
    Circulation, 2005
    Co-Authors: Shunichi Homma, Ralph L Sacco
    Abstract:

    Observational data from prospective and retrospective trials indicate that a Patent Foramen Ovale (PFO) is associated with the risk of ischemic stroke. The mechanism involved is presumed to be paradoxical embolism from a venous thrombus that travels via the PFO to the systemic circulation causing an ischemic stroke. Primary stroke prevention data for patients with a PFO are nonexistent. Given the substantial prevalence of PFO in the total population (≈25% to 30%), a primary prevention study may not be feasible. However, whether targeted primary prevention for patients with PFOs of certain morphologic characteristics (eg, larger size, greater degree of shunt) would be possible remains undefined. Given the large number of asymptomatic subjects, no therapy is currently recommended. The best treatment modality to prevent recurrent stroke in patients with PFO has not been defined. There are four major treatment choices: surgical closure, percutaneous device closure, medical therapy with anticoagulants, and medical therapy with antiplatelet agents. Regarding medical therapy, the Patent Foramen Ovale in Cryptogenic Stroke Study has demonstrated that antiplatelet and anticoagulant therapies are of equal benefit in preventing recurrent adverse events. Although closure of the PFO, either surgical or percutaneous, may further reduce the event rates, this remains to be demonstrated because no randomized trial to date has compared PFO closure with medical therapy.

  • characteristics of Patent Foramen Ovale associated with cryptogenic stroke a biplane transesophageal echocardiographic study
    Stroke, 1994
    Co-Authors: Shunichi Homma, Ralph L Sacco, Marco R Di Tullio, D Mihalatos, Li G Mandri, J P Mohr
    Abstract:

    Patent Foramen Ovale is associated with ischemic stroke in patients without a clearly identifiable etiology for stroke (cryptogenic stroke). Paradoxical embolization is thought to be a potential mechanism. However, Patent Foramen Ovale is also found in patients with known cause of stroke. Therefore, using contrast transesophageal echocardiography, we characterized the Patent Foramen Ovale in cryptogenic stroke patients to assess morphological factors that may contribute to paradoxical embolization. Contrast transesophageal echocardiographic studies of 74 consecutive patients referred for ischemic stroke were reviewed. Twenty-three patients with Patent Foramen Ovale were identified. These patients were classified as having strokes of determined origin or cryptogenic strokes according to criteria developed for the Stroke Data Bank of the National Institute of Neurological Disorders and Stroke. Separation of septum primum from secundum and the number of microbubbles appearing in left atrium were then quantitated. These parameters were compared between patients with cryptogenic stroke and those with known cause of stroke. The Patent Foramen Ovale dimension was significantly larger in patients with cryptogenic stroke compared with patients with an identifiable cause of stroke (2.1 +/- 1.7 mm versus 0.57 +/- 0.78 mm [mean +/- SD]; P Patients with cryptogenic stroke have larger Patent Foramen Ovale with more extensive right-to-left interatrial shunting than patients with stroke of determined cause. Transesophageal echocardiographically identifiable characteristics of Patent Foramen Ovale may be important in defining the clinical significance of individual Patent foramina.

  • comparison of diagnostic techniques for the detection of a Patent Foramen Ovale in stroke patients
    Stroke, 1993
    Co-Authors: Marco R Di Tullio, Ralph L Sacco, J P Mohr, N Venketasubramanian, D Sherman, Shunichi Homma
    Abstract:

    The prevalence of a Patent Foramen Ovale has been shown to be increased in patients with ischemic stroke. Transesophageal echocardiography, transthoracic echocardiography, and transcranial Doppler examination with contrast injection can all be used to search for a Patent Foramen Ovale. We compared the accuracy of these techniques for identifying a Patent Foramen Ovale in 49 patients with acute ischemic stroke or transient ischemic attack.Transcranial Doppler examination of the right middle cerebral artery was performed during simultaneous transthoracic echocardiography with aerated saline injection, and again during transesophageal echocardiography; the latter was adopted as the "gold standard" for assessing the sensitivity of the other two tests.Contrast transesophageal echocardiography detected a Patent Foramen Ovale in 19 of 49 patients (39%), during normal respiration in 15 of them and during Valsalva maneuver in 4. Transcranial Doppler correctly identified 13 patients with a Patent Foramen Ovale and ...

Annette Geibel - One of the best experts on this subject based on the ideXlab platform.

  • Patent Foramen Ovale and cryptogenic stroke in older patients.
    The New England Journal of Medicine, 2007
    Co-Authors: Michael Handke, Andreas Harloff, Manfred Olschewski, A Hetzel, Annette Geibel
    Abstract:

    A b s t r ac t BACKGROUND Studies to date have shown an association between the presence of Patent Foramen Ovale and cryptogenic stroke in patients younger than 55 years of age. This association has not been established in patients 55 years of age or older. METHODS We prospectively examined 503 consecutive patients who had had a stroke, and we compared the 227 patients with cryptogenic stroke and the 276 control patients with stroke of known cause. We examined the prevalences of Patent Foramen Ovale and of Patent Foramen Ovale with concomitant atrial septal aneurysm in all patients, using transesophageal echocardiography. We also compared data for the 131 younger patients (

  • Patent Foramen Ovale and cryptogenic stroke in older patients
    The New England Journal of Medicine, 2007
    Co-Authors: Michael Handke, Andreas Harloff, Manfred Olschewski, A Hetzel, Annette Geibel
    Abstract:

    A b s t r ac t BACKGROUND Studies to date have shown an association between the presence of Patent Foramen Ovale and cryptogenic stroke in patients younger than 55 years of age. This association has not been established in patients 55 years of age or older. METHODS We prospectively examined 503 consecutive patients who had had a stroke, and we compared the 227 patients with cryptogenic stroke and the 276 control patients with stroke of known cause. We examined the prevalences of Patent Foramen Ovale and of Patent Foramen Ovale with concomitant atrial septal aneurysm in all patients, using transesophageal echocardiography. We also compared data for the 131 younger patients (<55 years of age) and those for the 372 older patients (≥55 years of age). RESULTS The prevalence of Patent Foramen Ovale was significantly greater among patients with cryptogenic stroke than among those with stroke of known cause, for both younger patients (43.9% vs. 14.3%; odds ratio, 4.70; 95% confidence interval [CI], 1.89 to 11.68; P<0.001) and older patients (28.3% vs. 11.9%; odds ratio, 2.92; 95% CI, 1.70 to 5.01; P<0.001). Even stronger was the association between the presence of Patent Foramen Ovale with concomitant atrial septal aneurysm and cryptogenic stroke, as compared with stroke of known cause, among both younger patients (13.4% vs. 2.0%; odds ratio, 7.36; 95% CI, 1.01 to 326.60; P = 0.049) and older patients (15.2% vs. 4.4%; odds ratio, 3.88; 95% CI, 1.78 to 8.46; P<0.001). Multivariate analysis adjusted for age, plaque thickness, and presence or absence of coronary artery disease and hypertension showed that the presence of Patent Foramen Ovale was independently associated with cryptogenic stroke in both the younger group (odds ratio, 3.70; 95% CI, 1.42 to 9.65; P = 0.008) and the older group (odds ratio, 3.00; 95% CI, 1.73 to 5.23; P<0.001). CONCLUSIONS There is an association between the presence of Patent Foramen Ovale and cryptogenic stroke in both older patients and younger patients. These data suggest that paradoxical embolism is a cause of stroke in both age groups.

  • Patent Foramen Ovale in patients with haemodynamically significant pulmonary embolism.
    The Lancet, 1992
    Co-Authors: Wolfgang Kasper, Annette Geibel, N. Tiede, H. Just
    Abstract:

    Abstract The prevalence of a Patent Foramen Ovale is about 1 in 4. In cases with venous thromboembolism and raised right heart pressures, a Patent Foramen Ovale may permit paradoxical emboli, which could complicate the course of patients with pulmonary embolism. Echocardiography enables detection of a Patent Foramen Ovale in life. We have studied 85 patients who presented with haemodynamically significant pulmonary embolism as judged by clinical, echocardiographic, or haemodynamic indices and who had an echocardiographic evaluation for Patent Foramen Ovale. 33 patients (39%) had a Patent Foramen Ovale. Clinical symptoms suggestive of paradoxical embolism were more likely in patients with than in those without a Patent Foramen Ovale (39% vs 6%, p=0·00034), with new neurological deficits occurring in 11 patients (9 vs 2, p=0·005) and a vascular occlusion in 8 (7 vs 1, p=0·0096). Arterial oxygen tension was lower in patients with a Patent Foramen Ovale (mean 55 [SD 14] vs 62 [16] mm Hg, p=0·038). Mortality was not different between the two groups (27% vs 19%). Cardiopulmonary complications in terms of resuscitation, intubation, or the use of catecholamines were more frequently observed in patients with a Patent Foramen Ovale (48% vs 23%, p=0·028). Patients with a Patent Foramen Ovale and haemodynamically significant pulmonary embolism are more likely to have arterial hypoxaemia and vascular occlusions, possibly due to paradoxical emboli.

Krassen Nedeltchev - One of the best experts on this subject based on the ideXlab platform.

  • prevention of stroke in patients with Patent Foramen Ovale
    International Journal of Stroke, 2010
    Co-Authors: Heinrich Mattle, Bernhard Meier, Krassen Nedeltchev
    Abstract:

    Patent Foramen Ovale is found in 24% of healthy adults and 38% of patients with cryptogenic stroke. This ratio and case reports indicate that Patent Foramen Ovale and stroke are associated, probably because of paradoxical embolism. In healthy people with Patent Foramen Ovale, embolic events are not more frequent than in controls, and therefore no primary prevention is needed. However, once ischaemic events occur, the risk of recurrence is substantial and prevention becomes an issue. Acetylsalicylic acid and warfarin reduce this risk to the same level as in patients without Patent Foramen Ovale. Patent Foramen Ovale with a coinciding atrial septal aneurysm, spontaneous or large right-to-left shunt, or multiple ischaemic events potentiates the risk of recurrence. Transcatheter device closure has therefore become an intriguing addition to medical treatment, but its therapeutic value still needs to be confirmed by randomised-controlled trials.